The immediate issue is the use of brain amyloid scanning, which allows doctors to identify clusters of proteins in the brain that are associated with Alzheimer's. Researchers have used this tool for several years and, thanks to new advancements, it can now be made available at the clinical level for physicians to use with patients who are exhibiting cognitive impairments. The Center for Medicare and Medicaid Services (CMS) has issued a preliminary decision that it will only provide coverage for use of the scan in clinical trials, but not make it more widely accessible, suggesting that it will not improve health outcomes for patients with dementia. A final decision is expected this fall.
This should stir a broader debate about how open federal decisionmakers should be toward new diagnostic technologies given the extraordinary healthcare challenges we're facing in the years ahead. Today, chronic illnesses account for 95 percent of all Medicare spending and eight of every 10 senior citizens have at least one chronic disease. Of even greater concern, incidence rates for most of these conditions are soaring. For Alzheimer's alone, patient care is projected to cost Medicare and Medicaid over $1.2 trillion annually by 2050, endangering the financial sustainability of these programs.
True, CMS is correct in observing that an enhanced ability to diagnose Alzheimer's doesn't necessarily lead to a better outcome for the patient (although it can be argued that patients and the system both benefit if a brain amyloid scan can rule out the possibility of Alzheimer's). But, that's only a compelling argument if we view this new technology as the be-all, end-all of diagnostic care and treatment for dementia patients.
In reality, medical technology innovation is an incremental process. When one new innovation is approved and put into use, it leads to the next new breakthrough and then the next. We've seen that, for example, in the progress that has been made in therapies for HIV/AIDS patients. Early innovations, made available to patients, have led us to the point where there are very promising candidates to vaccinate against or cure the disease. To achieve tangible, improved outcomes for patients, we have to allow the wheels of progress to turn.
A cost-efficient, quality-driven healthcare system won't be achieved by curbing innovation to save money in the short term. We need to encourage the research and development that will lead to more exciting and beneficial breakthroughs. Diseases like Alzheimer's are, unquestionably, going to cost our society in both lives and resources. The medical innovation decisions we make today will determine how extensive those costs will be.
Grealy is president of the Healthcare Leadership Council, an alliance of chief executives of many of the nation’s leading healthcare companies and organizations.